Metastatic liver cancer is cancer that has spread to the liver from another primary site in the body.
What is metastatic liver cancer?
Metastatic liver cancer, also called secondary liver cancer, occurs when cancer cells spread to the liver from another part of the body. This is different from primary liver cancer, which starts in the liver itself.
The most common cancers that spread to the liver are:
- Colorectal cancer: The liver is a very common site for colon cancer and rectal cancer to spread. A significant percentage of patients with advanced colorectal cancer will develop liver metastases.
- Breast cancer: Breast cancer frequently spreads to the liver, especially in later stages. The liver is one of the more common sites for distant metastases (spread) in breast cancer, along with bone, lung, and brain.
- Lung cancer: Lung cancer is aggressive and often metastasizes to various sites, including the liver. The liver is a relatively common site of metastasis for lung cancer.
- Pancreatic cancer: Pancreatic cancer is highly aggressive and often diagnosed at a late stage when it has already spread. Liver cancer spread is common in pancreatic cancer.
- Stomach cancer: Stomach cancer can spread to the liver, although it may be less common than other sites like the peritoneum (lining of the abdominal cavity) or lymph nodes. Liver cancer spread does occur, especially in more advanced stages.
Metastatic liver cancer is actually more common than primary liver cancer. This is because the liver's function and extensive blood supply make it a frequent site for cancer cells to spread from other parts of the body.
AHN Liver, Bile Duct, and Gallbladder Cancer Center of Excellence
At our Liver, Bile Duct, and Gallbladder Cancer Center of Excellence, we provide comprehensive care for patients diagnosed with hepato-pancreato-biliary (HPB) cancers such as hepatocellular carcinoma (HCC) and biliary tumors, including cholangiocarcinoma and gallbladder cancer. The team, made up of oncologists, hepatologists, surgeons, pathologists, and radiologists, deeply understands the complexities of these liver, bile duct, and gallbladder cancers. Working in a multidisciplinary manner, your AHN care team works together to develop personalized treatment plans that aim to achieve the best possible outcome.
Why choose AHN for metastatic liver cancer care?
When you choose care at AHN, you will experience a comprehensive approach diagnosing and treating metastatic liver cancer. Each patient will experience a tailored approach that includes:
- Multidisciplinary care expertise: Our team of experts includes surgeons, oncologists, hepatologists, and radiologists collaborating to develop personalized treatment plans.
- Advanced technology: We offer advanced diagnostic and treatment technologies, including minimally invasive surgical techniques, advanced imaging, and targeted radiation therapies.
- Clinical trials: We participate in clinical trials, giving patients access to cutting-edge treatments.
- Supportive care services: We provide comprehensive supportive care services to address the physical, emotional, and social needs of patients and their families.
Metastatic liver cancer symptoms and signs
It is important to note that these symptoms can be caused by other conditions as well. If a patient is experiencing these symptoms, they should consult with a health care professional for a proper diagnosis. Keep in mind that not everyone experiences all of these, and the specific symptoms can vary depending on the extent and location of the cancer. Metastatic liver cancer symptoms can affect people differently.
The symptoms of metastatic liver cancer can be diverse and may overlap with other conditions. It's important to be aware of these potential signs:
- Abdominal pain or discomfort: Often felt in the upper right abdomen.
- Weight loss: Unexplained and unintentional weight loss.
- Loss of appetite: Feeling full quickly or not feeling hungry.
- Nausea and vomiting: Can occur due to liver dysfunction or the cancer itself.
- Fatigue: Persistent and overwhelming tiredness.
- Jaundice: Yellowing of the skin and whites of the eyes.
- Ascites: Swelling in the abdomen due to fluid buildup.
- Hepatomegaly: Enlargement of the liver, which can be felt by a doctor during an exam.
Less common symptoms may include:
- Fever: Unexplained or persistent fever.
- Itching: Generalized itching of the skin (pruritus).
- Enlarged spleen (splenomegaly): Can cause discomfort in the upper left abdomen.
- Confusion or memory problems: In severe cases, liver dysfunction can lead to neurological symptoms.
- Swelling in the legs and ankles (edema): May occur due to fluid retention.
- Variceal bleeding: Enlarged veins in the esophagus or stomach may bleed, leading to vomiting blood or black, tarry stools.
Causes and risk factors
Since metastatic liver cancer is caused by the spread of cancer from another site, the primary "cause" is having a different type of cancer that is capable of spreading to the liver. The risk factors are essentially the risk factors for developing those primary cancers. The liver is a common site for metastasis because of its rich blood supply. Colorectal cancer is a common disease that can spread and develop into metastatic liver cancer. The risk factors for colorectal include advanced age, family history, inflammatory bowel disease, and a diet high in red meat. Other cancer types can also develop into metastatic liver disease. Those include:
- Breast cancer
- Pancreatic cancer
- Stomach cancer
Metastatic liver cancer screening and diagnosis
Since metastatic liver cancer is the result of cancer spreading from another site, screening focuses on individuals already diagnosed with a primary cancer that has a high likelihood of spreading to the liver. Screening is typically done for individuals already diagnosed with a primary cancer that has a high risk of spreading to the liver (e.g., colorectal cancer, breast cancer, lung cancer, pancreatic cancer). The frequency of screening depends on the type of primary cancer, its stage, and individual risk factors. Your doctor will talk with you about what the appropriate schedule looks like for your health needs.
A thorough physical exam and review of your medical history are essential for diagnosis. If metastatic liver cancer is suspected, additional tests are ordered. Your AHN care team will help you understand what this personalized plan will look like. The right tests will give your care team the right information they need.
Imaging Tests
- CT scan (computed tomography): Provides detailed cross-sectional images of the liver and surrounding organs. Often the first imaging test used.
- MRI (magnetic resonance imaging): Another detailed imaging technique that can be very helpful in detecting and characterizing liver lesions.
- Ultrasound: Less detailed than CT or MRI, but can be useful as an initial screening tool or to guide biopsies.
- PET scan (positron emission tomography): May be used to look for cancer spread throughout the body.
- Liver biopsy: A small sample of liver tissue is removed and examined under a microscope. This is the most definitive way to confirm the diagnosis of metastatic liver cancer and determine the type of cancer cells. The biopsy can be done using a needle inserted through the skin (percutaneous biopsy) or during surgery.
Blood Tests
- Liver function tests (LFTs): These blood tests measure liver enzymes and other substances to assess liver function. Abnormal LFTs can indicate liver damage or disease.
- Tumor Markers: In some cases, blood tests for tumor markers (e.g., CEA for colorectal cancer) may be helpful.
Types and stages of metastatic liver cancer
Metastatic liver cancer is cancer that has spread from another part of the body. The "type" really refers to the origin of the primary cancer. Types of metastatic liver cancer include:
- Metastatic colorectal cancer to the liver: This is one of the most common types. The cancer cells in the liver are colorectal cancer cells.
- Metastatic breast cancer to the liver: The cancer cells are breast cancer cells that have spread.
- Metastatic lung cancer to the liver: The cancer cells originated in the lung.
- Metastatic pancreatic cancer to the liver: The cancer cells originated in the pancreas.
- Metastatic gastric (stomach) cancer to the liver: The cancer cells originated in the stomach.
- Other cancers: Many other cancers can potentially spread to the liver, though less frequently. These might include melanoma, kidney cancer, sarcomas, etc.
Since metastatic liver cancer, by definition, has already spread, the staging focuses on the extent of the spread. While primary liver cancer uses a different staging system, metastatic cancer is often described differently. The factors that are considered to determine staging include:
- Original (primary) cancer: The type and stage of the original cancer are critical. For example, metastatic colon cancer to the liver is staged based on the original colon cancer stage at diagnosis, along with information about the spread.
- Number and size of liver tumors: The number of tumors in the liver and their size are important factors.
- Spread to other areas: Whether the cancer has spread to other organs or lymph nodes beyond the liver is also considered.
- Patient's overall health: The patient's general health and ability to tolerate treatment are also taken into account.
Once your health care providers have the information they need, they can stage the cancer. Instead of specific numerical stages (like Stage 1, 2, 3, or 4), metastatic liver cancer is often described based on specific health factors. These often include:
- Resectable: This means the tumors in the liver can be surgically removed.
- Unresectable: This means the tumors cannot be removed surgically, often due to their size, location, or number, or because the patient's overall health doesn't allow for surgery.
- Extent of disease: Doctors will describe how widespread the cancer is in the liver and whether it has spread to other parts of the body.
- Specific sites of metastasis: The specific organs or lymph nodes to which the cancer has spread will be identified (e.g., "metastatic colon cancer to the liver and lungs").
Metastatic liver cancer treatment
The specific treatment approach depends on several factors, including:
- The type and stage of the primary cancer.
- The extent of the liver metastases (number, size, and location of tumors).
- Whether the cancer has spread to other parts of the body.
- The patient's overall health and preferences.
The AHN Liver, Bile Duct, and Gallbladder Cancer Center of Excellence uses the most advanced liver cancer treatments, and care team review your treatment options with you so you feel confident in your care.
Surgery (resection)
If the liver metastases are limited in number and location, and if the patient is healthy enough, surgery to remove the tumors may be an option. This is most often considered when the primary cancer is colorectal cancer. The primary goal of surgery for metastatic liver cancer is to remove as much of the cancerous tissue as possible, ideally leading to improved outcomes and prolonged survival. Key considerations for surgery often include:
- Source of the metastasis: The type of primary cancer that has spread to the liver significantly impacts the surgical approach and prognosis. For example, metastatic colorectal cancer often has different surgical considerations than metastatic breast cancer.
- Number, size, and location of tumors: The number of tumors in the liver, their size, and their location are crucial factors. If there are too many tumors, if they are too large, or if they are located near critical blood vessels or bile ducts, surgery may not be feasible.
- Extent of disease outside the liver: If the cancer has spread significantly to other organs, surgery may not be the best option.
- Patient health: The patient's general health, liver function, and ability to tolerate major surgery are carefully evaluated.
- Liver function reserve: Surgeons assess how much healthy liver tissue remains and its ability to function after a portion is removed.
- Liver transplantation: This is a treatment option for highly selected patients with unresectable liver-only metastatic liver disease.
Ablation
Ablation is a minimally invasive technique used to destroy liver tumors without surgically removing them. It works by delivering energy directly to the tumor, causing it to heat up or freeze, ultimately leading to cell death. Ablation is often used as an alternative or adjunct to surgery in certain cases of metastatic liver cancer. The different types include:
- Radiofrequency ablation (RFA): Uses heat to destroy tumors.
- Microwave ablation: Uses microwave energy to destroy tumors.
- Cryoablation: Uses extreme cold to freeze and destroy tumors.
- Chemical ablation: Involves injecting alcohol directly into the tumor to kill the cancer cells.
Embolization techniques
Embolization is a minimally invasive procedure used to treat metastatic liver cancer by blocking the blood supply to the tumor(s). Liver tumors, like all cancers, need a constant supply of oxygen and nutrients to grow. Embolization aims to cut off this supply, causing the tumor cells to die. Techniques used may include:
- Transarterial Chemoembolization (TACE): Chemotherapy drugs are injected directly into the artery that feeds the liver tumor, followed by blocking the artery.
- Selective Internal Radiation Therapy (SIRT) or Radioembolization: Tiny radioactive beads are injected into the artery that feeds the liver tumor.
Radiation therapy
Radiation therapy uses high-energy rays to kill cancer cells. It is not used as often for liver metastases due to concerns about liver damage, but it may be considered in certain situations.
Targeted therapy
These drugs target specific molecules (proteins, genes) that help cancer cells grow and spread. They are often used when the cancer cells have certain mutations or characteristics. Examples include:
- Colorectal cancer: Drugs targeting EGFR (epidermal growth factor receptor) or VEGF (vascular endothelial growth factor).
- Breast cancer: Drugs targeting HER2 (human epidermal growth factor receptor 2) or hormone receptors (estrogen receptor, progesterone receptor).
Immunotherapy
These drugs help the body's immune system fight cancer. They are sometimes used for certain types of cancer that have spread to the liver. An example of an immunotherapy drug includes PD-1/PD-L1 inhibitors. These drugs block proteins that prevent the immune system from attacking cancer cells.
Chemotherapy
Chemotherapy drugs kill cancer cells throughout the body. It's often used for cancers that have spread widely. The specific drugs used depend on the type of primary cancer.
Clinical trials
AHN is an active participant clinical trials that help our patients find new and emerging treatments. Work with your care team to help identify which active clinical trial might be right for you.
Palliative care
Palliative care focuses on relieving symptoms and improving the quality of life for patients with serious illnesses like metastatic cancer. It can include pain management, nutritional support, and emotional support.
Metastatic liver cancer FAQs
A metastatic liver cancer diagnosis will often bring about questions, concerns, and a wide array of emotions. AHN is here for you. To help you feel more grounded in your diagnosis and feel prepared to speak with your care team about your options, we’ve provided some of our patients’ most frequently asked questions as a resource.
When cancer spreads to the liver, what is my life expectancy?
It's very difficult to give a precise life expectancy for someone with metastatic liver cancer. Life expectancy depends on many factors, including:
- The type of primary cancer: Some cancers are more aggressive than others.
- The stage of the primary cancer at diagnosis: More advanced primary cancers tend to have a poorer prognosis.
- The number and size of liver metastases: More extensive disease typically has a worse prognosis.
- The patient's overall health and response to treatment: A patient's general health and how well they respond to treatment can significantly impact survival.
- Available treatment options: Advances in treatment can improve outcomes.
- Time between primary cancer diagnosis and liver metastases: A longer interval may be a positive prognostic factor in some cancers.
Because of these variables, survival can range from several months to several years. Your oncologist can provide a more personalized estimate based on your specific situation. They will consider all the factors mentioned above, along with the latest research and treatment guidelines. Statistical averages (like "median survival") can be misleading because they don't account for individual differences.
How fast do liver metastases grow?
The growth rate of liver metastases varies greatly depending on the type of cancer, the individual patient, and other factors. Some metastases may grow slowly over months or years, while others can grow more rapidly. Some cancers, like certain types of colorectal cancer, are known to have relatively rapid growth rates in the liver.
Imaging studies (CT scans, MRI) are used to monitor the growth of liver metastases over time. The frequency of these scans will depend on your specific situation and the treatment plan. Your doctor will use these scans to assess the effectiveness of treatment and make any necessary adjustments. Factors affecting growth rate include the tumor's blood supply, the presence of growth factors, and the tumor's inherent biological characteristics.
Is metastatic liver cancer curable?
In most cases, metastatic liver cancer is not curable. However, this does not mean that treatment is not worthwhile. The goals of treatment for metastatic liver cancer are typically to:
- Control the growth of the cancer: Slow down or stop the progression of the disease.
- Relieve symptoms: Improve the patient's quality of life.
- Prolong survival: Extend the patient's life.
In certain very select cases, if the metastatic disease is limited to a small number of tumors that can be completely removed with surgery or ablated, and the primary cancer is well-controlled, there might be a chance of long-term remission. However, this is uncommon.
Research is ongoing to develop new and more effective treatments for metastatic liver cancer, and there have been significant advances in recent years. These advances are helping patients live longer and with a better quality of life. Palliative care to manage symptoms and side effects is also an important part of the overall treatment plan.
Contact us
Call the Hope Line at (412) 578-HOPE 412-578-4673 to connect with a nurse navigator or schedule an appointment. This number provides patients appointments with surgical oncology only and our service (Department of abdominal transplantation and hepatobiliary surgery) never gets a referral when patients call this number. We need to have a way to also refer patients to our service when this number is called.
Second opinions
If you have cancer, you have a team of oncology specialists ready to review your medical records and offer you a second opinion. After completing their review, they’ll talk with you about your goals to determine a course of treatment that’s right for you. To get started, fill out our Second Opinion Request form. A nurse navigator will contact you within the next 24 to 48 hours to discuss next steps and schedule.